| NPI | 1659312809 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4704141333) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MI 6301007946) |
| 363LF0000X Nurse Practitioner, Family (Licence: MI 4704141333) | |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2010-09-15 |